Medicare Advantage vs. Medigap vs. ?????

[RobbieB]

For me it's 18 vs 79 a month. Might pay more later as visits go up, but now think it's less for standard vs enhanced.

 

[Hermit]

I decided to go with Medicare Advantage. The main reason was so I could get in the Kaiser system when I get old enough to move out of the mountains. Kaiser was available here in the mountains for a couple of years, but they have pulled back out starting next year. I have used Humana for the last few years. All seem to use the same doctors in this area.

 

[rk911]

This is well-plowed ground on the forum, but FWIW:

Medigap is our choice for a number of reasons, primarily for the ability to utilize any physician or facility that accepts Medicare assignment.

this. plus we wanted to stay with Blue Cross/Blue Shield. we travel the country for months at a time in our RV. their part c plans (medicare advantage) plans (at the time in 2015) required us to notify them 2-weeks in advance if we were changing our location. we sometimes don't know where we'll be in 2-days much less 2-weeks. their part c plans may no longer have that restriction but we like having the freedom to see any doc who accepts medicare without a referral.

 

[MBSC]

I wouldn’t do a advantage plan because of the step process and needing referrals.

MA PPO plans do not require referrals.

PPO plans do not require that beneficiaries use in-network providers and do not require a referral to see a specialist.

Source: https://www.ehealthmedicare.com/faq/what-are-the-differences-between-medicare-hmos-and-ppos/

Referrals: PPO plans have never had this requirement, and many of today’s HMO plans are going to “open access” and dropping their referral requirements altogether.

Source: https://www.psmbrokerage.com/blog/a...e-certified-and-sell-medicare-advantage-plans

 

[Dtail]

MA PPO plans do not require referrals.

MBSC
As one of the main resident experts on Medicare rules on this site, can you look at my Post #9 and let me know your thoughts?

 

[MBSC]

A related side question.
My DGF who is receiving SSDI at 58 y.o., is currently on an MA plan.
If she switched out of it before 65 y.o., would there be an underwriting required?

MBSC
As one of the main resident experts on Medicare rules on this site, can you look at my Post #9 and let me know your thoughts?

If she also lives in FL, then yes Medigap underwriting would be required. It's usually an automatic denial for those under 65 outside their 6-month Medigap Initial Enrollment Period who do not qualify for a Medigap Guarantee Issue right (ie. moving outside the MA service area).

Also, Under 65 Medigap Plan G is about $450-$500/month in Tampa. At age 65, she will be entitled to the same Medigap Open Enrollment Period everyone else gets and will pay the same preferred rate as others.

 

[Dtail]

If she also lives in FL, then yes Medigap underwriting would be required. It's usually an automatic denial for those under 65 outside their 6-month Medigap Initial Enrollment Period who do not qualify for a Medigap Guarantee Issue right (ie. moving outside the MA service area).

Also, Under 65 Medigap Plan G is about $450-$500/month in Tampa. At age 65, she will be entitled to the same Medigap Open Enrollment Period everyone else gets and will pay the same preferred rate as others.

Thanks MBSC.
Sounds like she will keep the MA plan for the foreseeable future. All doctors in this area (Tampa) accept her plan, plus the MOOP is 5,900 currently.

 

[DektolMan]

I turn 65 next year so I have been doing my research as well. My friends have an Advantage plan, zero premiums and lots of extras and they love it. So I know they travel 6-8 weeks a year with their RV and I asked if they are covered in out of network.


They said there plan includes Emergency/Urgent care coverage while traveling. So I called the insurance company to dig deeper and they confirmed that the emergency travel is covered.


Then I ask what is the out of network deductible and they say I have zero coverage out of network. So I ask if I'm in a car accident out of state, go to the Emergency room and admitted to a hospital bed for 3 days am I covered? Well the emergency room is covered but as soon as you leave emergency care and go to a hospital bed you have zero coverage and you are responsible for 100%.


I plan on getting Medicare with Plan G-HD to make sure I have coverage while traveling.

 

[John Galt III]

Basically if you are concerned about the "Initial" costs, do not mind a limited availability of service providers, do not need national coverage, do not mind checking with the provider rep every time you need something done to confirm coverage, then MA is for you.

If you do not mind the ~$200 a month ($2,400 pa + ~$200 deductible) extra costs with none of the above limitations then the "G" supplement is for you.

Depending on your drugs an extra Part D will also be needed with the supplement.

Remember though that the MOOP for the MA plans is about ~$6,700, quite high. I paid $3,791 for all in 2019, and used every bit of it and then some. It would have cost me almost double with an Advantage plan.

So it is a pay me now or pay me later for some folks depending on your ailments. Remember after 6 months or 1 year to switch to a Supplement form a MA plan requires medical underwriting.

So there you go.

ShockWave, the $3,791 is premiums plus out-of-pocket costs? Curious what you had to pay for besides premiums, since I keep hearing people with a supplement never have to pay anything except the premiums. Thanks. I have a MA plan now but am still thinking of going to supplement possibly.

 

[kaneohe]

Here's a table of the standardized supplement plans. Standardization is nice because all the plans w/ the same letter are the same. A common plan these days is Plan G.............there is a small deductible but after that all costs are covered which makes it easy to track what you owe.......which is nothing.
There are some other plans that have copayments.

btw ......a YES in the table means it is covered.

https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies

 

[ShokWaveRider]

ShockWave, the $3,791 is premiums plus out-of-pocket costs? Curious what you had to pay for besides premiums, since I keep hearing people with a supplement never have to pay anything except the premiums. Thanks. I have a MA plan now but am still thinking of going to supplement possibly.

No OOP costs just Medicare and supplement premiums. That is the Point. The MOOP on most MA Plans in our area is $6700 minimum.

 

[Teacher Terry]

I have a friend on a Medicare advantage program that is not getting the surgery she needs. She has been in and out of the hospital and was told she needed surgery for a leaky heart valve. Her BF has been trying to advocate for her. Now she’s back in the hospital with fluid filling up. She is 78.

 

[Katsmeow]

I went with traditional Medicare and a Supplement (G) for two reasons:

1. I don't want to have to pick doctors in a network. I don't want to be even in a PPO with lesser reimbursement for out of network doctors. The great relief of Medicare is that I no longer had to worry about any of that. Why would I want to put myself back into that? I like being able to see any doctor that takes Medicare and almost all of them do. Since DH was on Medicare (6 years) and I have gone on Medicare this year I have only found one doctor I wanted to see who didn't take Medicare (an allergist). Otherwise, it really hasn't been an issue.

2. The big dealbreaker though is that if you leave Medicare Advantage and want to go back to traditional medicare you usually have to have underwriting for your supplement and you may not be able to qualify. Sure, I might be able to qualify now but who know what happens later. I would not want to be locked into Medicare advantage.

 

[mf15]

I turn 65 next year so I have been doing my research as well. My friends have an Advantage plan, zero premiums and lots of extras and they love it. So I know they travel 6-8 weeks a year with their RV and I asked if they are covered in out of network.


They said there plan includes Emergency/Urgent care coverage while traveling. So I called the insurance company to dig deeper and they confirmed that the emergency travel is covered.


Then I ask what is the out of network deductible and they say I have zero coverage out of network. So I ask if I'm in a car accident out of state, go to the Emergency room and admitted to a hospital bed for 3 days am I covered? Well the emergency room is covered but as soon as you leave emergency care and go to a hospital bed you have zero coverage and you are responsible for 100%.


I plan on getting Medicare with Plan G-HD to make sure I have coverage while traveling.

As of this time, there is no Plan G-HD.
Oldmike

 

[DektolMan]

I was told that since Plan F and Plan F-HD will not be available to new Medicare applicants that there will be a Plan G-HD. Pricing will come out sometime in December.
I called Boomer benefits and they confirmed this.

 

[John Galt III]

One more item about MA. Drugs are not counted towards MOOP.
Olmike

Yes, that's one of the disadvantages of MA. If you need an expensive drug, injected or by IV in a hospital, even if it is covered, you have to pay coinsurance of 20%, with NO CAP. With a supplement and a Part D drug coverage, is there a cap on Part B drug costs, and is there coinsurance or copays for drugs? Talking about Part B drugs, administered by IV or injection, in the hospital.

 

[W2R]

My federal BCBS health insurance is more like a Medigap policy now that I am on Medicare, and I still have to pay for Medicare Part B and for the full cost of the health insurance which will be $253.30 in 2020. It acts like a Part D as well, so I don't need Part D.

Anyway, my benefits are amazing. I have paid nothing ($0.00 total except for prescriptions and dental care), since I went on Medicare five years ago. This even included paying nothing for two surgeries. No co-pays, no deductibles. My federal BCBS coverage is the main reason why I chose federal employment and stuck with it for so long.

Some Medicare Advantage plans have broad nationwide PPO networks that require no preapproval and include drug coverage. Like many other members, my choice is traditional Medicare with Supplemental and Plan D, but Medicare Advantage is a viable option for many.

Edit to add - low income seniors who cannot afford supplemental MediGap coverage plus separate Plan D drug, and also do not need a broad nationwide provider network may be better served with Medicare Advantage.

Frank is in this category. His retirement income is much lower than mine, because of retiring at a younger age due to huge layoffs at his megacorps. His retiree health insurance from work became insanely expensive for terrible benefits. So, when he turned 65 he chose a very popular local Medicare Advantage plan that includes all of his doctors, and provides much better benefits including not only terrific drug coverage but also free gym fees and costs less than conventional Medicare Part B.

 

[Dtail]

My federal BCBS health insurance is more like a Medigap policy now that I am on Medicare, and I still have to pay for Medicare Part B and for the full cost of the health insurance which will be $253.30 in 2020. It acts like a Part D as well, so I don't need Part D.

Anyway, my benefits are amazing. I have paid nothing ($0.00 total except for prescriptions and dental care), since I went on Medicare five years ago. This even included paying nothing for two surgeries. No co-pays, no deductibles. My federal BCBS coverage is the main reason why I chose federal employment and stuck with it for so long.


Frank is in this category. His retirement income is much lower than mine, because of retiring at a younger age due to huge layoffs at his megacorps. His retiree health insurance from work became insanely expensive for terrible benefits. So, when he turned 65 he chose a very popular local Medicare Advantage plan that costs him nothing, includes all of his doctors, and provides much better benefits including not only terrific drug coverage but also free gym fees and costs less than conventional Medicare Part B.

Your quote above about Frank got me thinking.
My DGF is now on Medicare Advantage, but when she went on SSDI, she was originally covered through an employer (not hers) and used regular Medicare as the supplemental coverage.
Thus Social Security started deducting for Medicare Part B, but now that she is on an MA plan, they continue to deduct the Part B.
1) Shouldn't they stop deducting the Part B?
2) If the answer to #1 is yes, then is there any entitlement of refunds?

EDIT
My DGF reminded me that they told her that if she didn't keep on paying the Medicare Part B while still having Medicare Advantage, that when she turned 65 y.o., she would be considered to have " missed" the original Medicare deadline and thus would be charged much heavier penalties.
This dovetails to some extent what MBSC alluded to in a prior post.

I still wonder though that even if she would be able to get regular Medicare at 65 y.o.(58 currently), but would still have to pass underwriting and has had 3 back surgeries already and thus would fail underwriting, then what would be the point in continuing to pay Part B if she doesn't have a realistic chance of switching to Medicare at 65?

 

[explanade]

T
Medigap is our choice for a number of reasons, primarily for the ability to utilize any physician or facility that accepts Medicare assignment.

That's the lesson we learned with my father.

He was on Kaiser Advantage.

When he had brain cancer, Kaiser would not release him to get a second opinion.

The clerks at their finance office said they never do.

We had to take their word that there was nothing which could be done, unless we paid out of pocket to have him transported and then admitted into UCSF or something along those lines.

Got our mother off Kaiser Advantage after that.

 

[W2R]

Your quote above about Frank got me thinking.

I don't have any answers to your questions. To tell you the truth, I am really terrible with understanding insurance but he is not and he has checked in to all this stuff and thinks it is a good deal. Frank only switched from his *extremely* costly retiree insurance to the Medicare Advantage plan last year when he turned 65. From what he says, he doesn't actually pay Medicare Part B but pays the Medicare Advantage plan instead for similar benefits, and it is about $30/month less than Part B.

He pays less for his drugs than I do with my fancy-pants Federal retiree insurance, but I think maybe he has a co-pay for doctor visits whereas I don't (?) Not sure. Anyway he is very happy with it.

 

[youbet]

Yes, that's one of the disadvantages of MA. If you need an expensive drug, injected or by IV in a hospital, even if it is covered, you have to pay coinsurance of 20%, with NO CAP.

This is not true of all MA plans. Just sayin' ..........

 

[youbet]

I don't have any answers to your questions. To tell you the truth, I am really terrible with understanding insurance but he is not and he has checked in to all this stuff and thinks it is a good deal. Frank only switched from his *extremely* costly retiree insurance to the Medicare Advantage plan last year when he turned 65. From what he says, he doesn't actually pay Medicare Part B but pays the Medicare Advantage plan instead for similar benefits, and it is about $30/month less than Part B.

He pays less for his drugs than I do with my fancy-pants Federal retiree insurance, but I think maybe he has a co-pay for doctor visits whereas I don't (?) Not sure. Anyway he is very happy with it.

There are some significant differences between various MA plans. It sounds like Frank has a good one. My DW has a good one as well, a MA PPO. No doc or hospital networks, reasonable OOP max, etc. And she's used it a lot (colon re-section followed by breast cancer with chemo and radiation) so she's deep into all the details of coverage. Picked the docs and specialists she wanted with no restrictions.

I chose traditional Medicare with a type F Select supplement. That's worked fine for me.

Many folks on this thread seem to be making the mistake of assuming all MA plans are similar when, in fact, there is much variation and you need to be a good shopper. Sounds like Frank is.

 

[youbet]

1) Shouldn't they stop deducting the Part B?

No. Da Gummit forwards her Part B payment to the MA provider. Then, if the MA provider charges more than the Part B amount, that difference shows up as a premium you must pay.

 

[Dtail]

I don't have any answers to your questions. To tell you the truth, I am really terrible with understanding insurance but he is not and he has checked in to all this stuff and thinks it is a good deal. Frank only switched from his *extremely* costly retiree insurance to the Medicare Advantage plan last year when he turned 65. From what he says, he doesn't actually pay Medicare Part B but pays the Medicare Advantage plan instead for similar benefits, and it is about $30/month less than Part B.

He pays less for his drugs than I do with my fancy-pants Federal retiree insurance, but I think maybe he has a co-pay for doctor visits whereas I don't (?) Not sure. Anyway he is very happy with it.

So it sounds like if Frank were ever to switch to Medicare instead of an MA plan, the premiums would be more than the standard charges if I understand the rules correctly.

 

[W2R]

So it sounds like if Frank were ever to switch to Medicare instead of an MA plan, the premiums would be more than the standard charges if I understand the rules correctly.

Oh I remember now! He doesn't have to pay anything for his MA plan. He pays for Part B, and then they refund part of that premium to him. Oops, sorry, my mistake.

See? I told you I am no good at understanding insurance.